Flashcards in First Aid: Substance Related Disorders Deck (158)
What is the DSM-IV criteria for substance abuse?
Pattern of substance use leading to impairment or distress for at least 1 year with 1 or more of the following manifestations:
-Failure to fulfill obligations at work, school or home
-Use in dangerous situations (ex. driving a car)
-Recurrent substance-related legal problems
-Continued use despite social or interpersonal problems due to the substance use
What is the DSM-IV criteria for substance dependence?
Dependence is substance use leading to impairment or distress manifested by at least 3 of the following within a 12-month period:
-Using substance more than originally intended
-Persistent desire or unsuccessful efforts to cut down on use
-Significant time spent in getting, using or recovering from substance
-Decreased social, occupational, or recreational activities because of substance use
-Continued use despite subsequent physical or psychological problem
What diagnosis supercedes substance abuse?
What is the lifetime prevalence of substance abuse or dependence in the US?
What is the gender difference in substance use and dependence?
men > women
What are the most commonly used substances?
What mood symptoms are common among those with substance abuse or dependence?
The development of a substance-specific syndrome due to the cessation of substance use that has been heavy and prolonged.
The need for increased amounts of the substance to achieve the desired effect or diminished effect if using the same amount of the substance.
What does ETOH do in the brain?
-Activates GABA (inhibitory) and serotonin receptors
-Inhibits glutamate receptors
What percentage of Americans are alcoholics?
List the first two steps in alcohol metabolism.
Alcohol dehydrogenase converts alcohol to acetaldehyde. Aldehyde dehydrogenase converts acetaldehyde to acetic acid.
True or false: alcohol is the most commonly abused substance in the USA?
What should be used to screen for alcohol abuse?
What is considered a positive CAGE?
two or more "yes" answer
At what BAL do most adults (>50%) show obvious signs of intoxication?
What is the legal limit for intoxication in most states?
.08 - .10 mg%
At what BAL do you see decreased fine motor control
.02 - .05 mg%
At what BAL do you see impaired judgement and coordination?
.05 - .1 mg%
At what BAL do you see ataxic gait and poor balance?
.1 - .15 mg%
At what BAL do you see lethargy and difficulty sitting upright?
.15 - .25 mg%
At what BAL do you see coma in the NOVICE drinker?
At what BAL do you see respiratory depression?
What medical phenomenon can methanol, ethanol and ethylene glycol all cause?
increased anion gap metabolic acidosis
What medications should be given to patients who present with altered mental status?
What is the treatment for acute ETOH intoxication?
-Ensure adequate airway, breathing and circulation
-Monitor electrolytes and acid-base status
-Obtain finger-stick glucose level to exclude hypoglycemia
-Thiamine, naloxone and folate
Why do you give thiamine to an intoxicated person?
to prevent or treat Wernicke's encephalopathy
Why do you give naloxone to an intoxicated person?
to reverse the effects of any opioids that may have been ingested
When would you use gastric lavage or charcoal in the treatment of ETOH overdose?
only if it is mixed ETOH-drug overdose
What is the treatment for alcohol dependence?
-Psychotherapy and SSRIs
What is disulfiram?
-Inhibits aldehyde dehydrogenase
-Causes violent retching when the person drinks
How does naltrexone help with ETOH dependence?
Opioid antagonist but helps to reduce cravings for ETOH
Why does ETOH withdrawal occur?
-Alcoholics have a chronically depressed CNS
-When the ETOH consumption ceases, the depressant effect is terminated and CNS excitation occurs
How long does it take ETOH withdrawal symptoms to occur after sober?
How long do ETOH withdrawal symptoms last?
List some mild s/s of ETOH withdrawal.
List some moderate s/s of ETOH withdrawal.
List some severe s/s of ETOH withdrawal.
Grand mal seizures
What are delirium tremens?
-The most serious form of ETOH withdrawal
-Delirium, visual or tactile hallucinations, gross tremor, autonomic instability, fluctuating levels of psychomotor activity
When do DTs usually start after cessation of drinking?
within 72 hours
What percentage of patients hospitalized for ETOH withdrawal develop DTs?
What is the prognosis for DTs?
15-20% mortality rate if untreated
How do you treat DTs?
adequate doses of benzodiazepines
How do you treat ETOH withdrawal?
-Tapering doses of chlordiazepoxide or lorazepam (benzos)
-Thiamine, folic acid and multivitamin (to treat nutritional deficiencies)
-Magnesium sulfate (for post-withdrawal seizures)
What is the name of the syndrome caused by thiamine (B1) deficiency resulting from the poor diet of alcoholics?
What are the symptoms of Wernicke's encephalopathy?
-Ocular abnormalities (nystagmus, gaze palsies)
What does untreated Wernicke's encephalopathy progress into?
Korsakoff's syndrome (chronic and often irreversible)
What are the symptoms of Korsakoff's syndrome?
Impaired recent memory
+/- Confabulation (making up answers when memory has failed)
What is VERY important to know when treated AMS?
Give thiamine BEFORE glucose (thiamine is coenzyme in carb metabolism and without it, W-K syndrome may be precipitated)
What is the MOA of cocaine?
-Blocks dopamine reuptake from the synaptic cleft, causing a stimulant effect on the reward system of the brain
List some s/s of cocaine intoxication.
Mimics "fight or flight" because it is a sympathomimetic:
-Increased or decreased BP
-Tachy or bradycardia
-Psychomotor agitation or depression
What types of hallucinations may be experienced by those on cocaine?
What cardiovascular complications are seen in those with cocaine intoxication?
MI or CVA due to vasoconstrictive effect
What is the differential diagnosis for cocaine intoxication?
How long with cocaine show up in a urine drug screen?
(longer in heavy users)
How do you treat cocaine intoxication?
-Benzos (mild to moderate agitation)
-Haloperidol (severe agitation or psychosis)
How do you treat cocaine dependence?
-DA agonists (amantadine, bromocriptine)
What happens when you abruptly abstain from cocaine?
What are symptoms of cocaine withdrawal?
-Psychomotor agitation or retardation
How do you treat cocaine withdrawal?
supportive (sleep off)
List the classic amphetamines.
-Methamphetamine (Ice, speed, "crystal meth", "crack")
List the substituted (designer) amphetamines.
What is the MOA of classic amphetamines?
-Release DA from nerve endings, causing a stimulant effect
What are classic amphetamines used to treat?
What is the MOA of designer amphetamines?
Release DA and serotonin from nerve endings, causing stimulant and hallucinogenic effect
What does someone with amphetamine intoxication look like?
similar to someone on cocaine
What is the differential for amphetamine intoxication?
What might chronic use of amphetamines in high doses cause?
Psychotic state that is similar to schizophrenia
How long can amphetamines be detected in the urine?
-Positive for 1-2 days
-Negative screen does not rule out amphetamines (usually most assays are not of adequate sensitivity)
How do you treat amphetamine intoxication?
Similar to cocaine
What is PCP also called?
What is the MOA of PCP?
Antagonizes NMDA (glutamate) receptors and activates dopaminergic neurons
What drug developed for anesthesia is similar to PCP?
What is pathognomonic for PCP intoxication?
What are some signs of PCP intoxication?
-High tolerance to pain
What may a PCP overdose cause?
seizures or coma
How do you treat PCP intoxication?
-Monitor BP, temp and electrolytes
-Acidify urine with ammonium chloride and ascorbic acid
-Benzos of dopamine antagonists to control agitation and anxiety
-Diazepam for muscle spasms and seizures
-Haloperidol to control severe agitation or psychotic symptoms
What is the differential diagnosis for PCP intoxication?
-Acute psychotic states
How long will a urine drug screen remain positive for PCP?
What enzymes are often elevated in patients who are on PCP?
Do patients on PCP have withdrawal symptoms?
no, but "flashbacks" may occur
Why are sedative-hypnotics commonly abused in the USA?
they are readily available
What is the MOA of benzos?
Potentiate effects of GABA by increasing FREQUENCY of chloride channel opening
What is the MOA of barbiturates?
Potentiate effects of GABA by increasing DURATION of chloride channel opening. Act as direct GABA agonists at high doses.
What are benzos used for?
What are barbiturates used for?
Which have a higher margin of safety, benzos or barbiturates?
How do benzos and barbiturates act in combination?
synergistic (may cause respiratory depression)
What are s/s of sedative intoxication?
-Death (esp barbiturates)
Which dose-specific CNS depressant is commonly used as a date rape drug?
What are s/s of GHB intoxication?
What is the differential diagnosis for sedative intoxication?
-Generalized cerebral dysfunction (ex. delirium)
How long do sedatives remain in serum drug screens?
Positive for 1 week
What is the general treatment for sedative intoxication?
-Activated charcoal to prevent GI absorption
What do you do if patient is intoxicated specifically with barbiturates?
Alkalinize urine with sodium bicarb to promote renal excretion
What do you give to a patient with benzo overdose?
Flumazenil (short acting benzo antagonist)
What is a potential side effect of flumazenil treatment?
Can precipitate seizures
Are short acting or long acting sedatives more likely to cause physicological dependence and withdrawal?
short acting (but long acting agents can as well)
What are the s/s of sedative withdrawal?
-Symptoms of autonomic hyperactivity (tachycardia, sweating, etc.)
What is unique about sedative withdrawal?
it can be life-threatening (compared to stimulants and hallucinogens)
What is the treatment for sedative-hypnotic withdrawal?
-Long acting benzo (chlorodiazepoxide or diazepam) and taper dose
-Tegretol or valproate for seizure control
List examples of opiates.
Dextromethorphan (cough syrup)
What is the MOA of opiates?
-Endogenous (endorphins and enkephalins) are involved in analgesia, sedation and dependence
-Effects on DA system (addictive and rewarding)
What is the different between opiates and opioids?
Opiates are naturally occurring chemicals that bind at opiate receptors. Opioids are synthetic chemicals that bind to the same receptors.
List s/s of opiate intoxication.
-Respiratory depression (may progress to coma or death in overdose)
Which opiate, if taken with an MAOI, may lead to serotonin syndrome?
What are s/s of serotonin syndrome?
-Hyper or hypotension
What is the differential diagnosis for opiate intoxicity?
-Sedative hypnotic intoxication
-Severe ETOH intoxication
What is the classic triad of opioid overdose?
How do you diagnose opiate overdose?
rapid recovery of consciousness following IV naloxone (opiate antagonist)
How long do opiates stay in urine and blood?
(can be positive in urine after a poppyseed muffin)
What is the risk with treating opiate OD with naloxone or naltrexone?
improve respiratory depression but may cause severe withdrawal in opiate-dependent patient
How do you treat opiate dependence?
-Oral methadone once daily, tapered over months to years
What is the only exception to opioids producing miosis?
What are some features of opiate withdrawal?
How do you treat opiate withdrawal?
-Moderate s/s: clonidine and/or buprenorphine
-Severe s/s: detox with methadone taper over 7 days
List some hallucinogens.
-Lysergic acid diethylamide (LSD)
What is the MOA of LSD?
acts on serotonergic system
True or false: hallucinogens show no tolerance
false: tolerance develops quickly and reduces rapidly after cessation
True or false: hallucinogens do NOT cause physcial dependence or withdrawal
What are s/s of hallucinogen intoxication?
What are the s/s of methyl pemoline (92C-B, U4EUH, Nexus) intoxication?
-Psychedelic distortion of the senses
-Feelings of harmony, anxiety, paranoid, and panic
How do you treat hallucinogen intoxication?
guidance and reassurance (talking down patient)
Why might someone get a flashback of hallucinogens later in life?
reabsorption from lipid stores
What drug can produce tachycardia, tachypnea, and hallucinations at high doses?
Ketamine (special K)
What is the main active component of cannabis?
What is the role of cannabinoid receptors in the brain?
inhibit adenylate cyclase
What can increase the effect of cannabis on the brain?
ETOH concurrent use
What is marijuana used to treat?
-Nausea in cancer patients
-Increase appetite in AIDS patients
What are s/s of marijuana intoxication?
What is the effect of dipping joints in embalming fluid?
How long is marijuana in the urine of a heavy smokr?
-Positive for up to 4 weeks
-Released from adipose stores
What are s/s of marijuana withdrawal?
NO WITHDRAWAL SYNDROME
List some things used as inhalants.
-Isobutyl nitrates (rush, bolt, locker room)
Who typically uses inhalants?
What is the chemical effect of inhalants?
generally act at CNS depressants
What are s/s of inhalant intoxication?
-Muscle weakness/ hyporeflexia
True or false: inhalants are not fatal.
FALSE: OD may be fatal 2/2 respiratory depression or arrhythmia
How do you treat inhalant intoxication?
-Psychotherapy and counseling
How long are inhalants detectable in serum drugs screens?
What are some symptoms of inhalant withdrawal?
What is the most commonly used psychoactive substance in the USA?
What is the MOA of caffeine?
adenosine antagonist (increasing cAMP and stimulating DA system)
How many mg of caffeine are in 1 cup of coffee?
How many mg of caffeine are in 1 cup of tea?
How many mg of caffeine can lead to intoxication?
What are s/s of caffeine intoxication?
How much caffeine must you intake to cause tinnitus, severe agitation and cardiac arrhythmias?
How much caffeine must you intake to cause death secondary to seizures and respiratory failure?
What are some symptoms of caffeine withdrawal?
How long does it take caffeine withdrawal symptoms to resolve?
within 1 week
What is the treatment for caffeine withdrawal?
-Taper consumption of caffeine-containing products
-Use analgesics to treat HA
-RARE short course of benzos to control anxiety
Where does nicotine act in the body?
nicotinic receptors in autonomic ganglia of sympathetic and parasympathetic nervous systems
Why is nicotine addictive?
effects DA system
What are the s/s of nicotine use?
-CNS stimulant (restlessness, insomnia, anxiety, increased GI motility)
What are some s/s of nicotine withdrawal?
What are treatment options for nicotine withdrawal?
-NRT (gum, patch)
-Zyban (antidepressant that reduces cravings)